Psychosocial interventions for managing occupational stress and burnout among medical doctors: a systematic review

Abstract

BackgroundOccupational stress and burnout are highly prevalent among medical doctors and can have adverse effects on patient, doctor, and organisational outcomes. The purpose of the current study was to review and evaluate evidence on psychosocial interventions aimed at reducing occupational stress and burnout among medical doctors.MethodA systematic review was conducted for original research articles reporting on psychosocial interventions targeting occupational stress or burnout among medical doctors, published in the English language, and with data collected at a minimum of two time points. Searches were conducted across five electronic databases, as well as by manual search of Google Scholar. Data was extracted relating to study characteristics and outcomes, quality and rigour, as well as modes of delivery and engagement. Studies were appraised using the Strength of Recommendation Taxonomy (SORT) and Critical Appraisal Skills Programme (CASP).ResultsTwenty-three articles were reviewed, which reported on interventions utilising cognitive-behavioural, relaxation, and supportive discussion strategies. Only 12 studies allowed estimation of pre- to post-intervention effects. Cognitive behavioural interventions demonstrated the strongest evidence, particularly for reducing stress. Some evidence was identified to support the efficacy of relaxation-based approaches, but no such evidence was found for the efficacy of discussion-based interventions, such as Balint groups. There was a lack of quality among reviewed studies, with no studies receiving a quality rating of 1, and the overall body of evidence being rated as level B, according to the SORT. Effect sizes were not pooled due to a lack of quality among the study sample.ConclusionThis review found that despite increased scientific attention, the quality of research examining the benefits of psychosocial/behavioural interventions for occupational stress and burnout in medical doctors remains low. Despite this, interventions focused on cognitive and behavioural principles appear to show promise in reducing doctor stress and burnout. Limitations of the current review include a lack of risk of bias assessment or pooling of analyses. Recommendations for improving the quality of research in this area, as well as implications of the current body of evidence are discussed.Systematic review registrationPROSPERO CRD42016032595Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-017-0526-3) contains supplementary material, which is available to authorized users.

A Randomized Controlled Trial of Balint Groups to Prevent Burnout Among Residents in China

“…Existing burnout interventions can be classified into physician-focused interventions, which target individuals, and organization-focused interventions, which target the working environment (39). The majority of previous studies have focused on physician-directed interventions and have typically involved mindfulness techniques, relaxation, stress management training, cognitive behavioral techniques, and Balint groups to reduce perceived pressure, improve communication skills, and enhance personal coping strategies (25). Organization-focused interventions include reductions in workload intensity (40), wellness teams (41,42), and mentoring programs (43,44).…”

“…Residents in China are at a high risk for burnout but few interventions exist and even fewer have been systematically tested in China specifically (25). Current findings and suggestions are not specific to Chinese doctors and lack consideration for Chinese culture.…”

Resilience on the Run: an evaluation of a well‐being programme for medical interns

“…5,16 Most of the original studies in these reviews have been undertaken in major metropolitan centres. 5,16 Most of the original studies in these reviews have been undertaken in major metropolitan centres.…”

“…Previous systematic reviews investigating interventions for managing occupational stress and burnout in doctors using mindfulness, cognitive behavioural and other relaxation interventions, have demonstrated benefits for participants. 5,16 Most of the original studies in these reviews have been undertaken in major metropolitan centres. There is a paucity of research evaluating the impact of programmes for interns in regional areas.…”

The WIT and the WES: Tools for Categorizing and Evaluating Physician Well-Being Programs

“…12,13 The ACGME well-being standards use this broader conceptualization. 8,9 We aggregated components of the ACGME standards 8 and published interventions to reduce burnout, 14,15 enhance well-being, 16 promote professional satisfaction, 17 expand mentoring 18 and peer support, 19 and increase physician engagement 20 into a single TABLE, the Well-being Interventions Typology (WIT). Like prior publications, 14,15,20 we characterized interventions as targeting individuals (residents or faculty), work units, programs, or institutions.…”